[Impact of the 2020 lockdown on prehospital psychiatric emergencies in a large city]

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic represented a serious challenge for healthcare systems worldwide. Special psychiatric patients represent a vulnerable group and are particularly affected by lockdown interventions. Knowledge on the possible effects for this group of patients in an emergency physician setting is low.

OBJECTIVE

The aim of this paper is to investigate the impact of the first lockdown during the COVID-19 pandemic in 2020 on emergency ambulance services for psychiatric patients in a large German city.

MATERIAL AND METHODS

A retrospective analysis was conducted on all prehospital psychiatric emergencies in a large German city during the first pandemic-related lockdown from 22 March 2020 to 4 May 2020, with the same period in 2019 serving as a reference.

RESULTS

During the first lockdown there was a significant increase in the number of emergency missions with respect to psychiatric cases. A substantial rise in substance-associated deployments was observed. Moreover, there was an increase in the proportion of psychiatric patients who did not meet emergency criteria. Suicidal tendencies and agitation status played a minor role during the lockdown.

CONCLUSION

The lockdown had a notable impact on the frequency and profile of emergency physician calls in the metropolitan area studied. The substantial increase in substance-associated callouts can be interpreted as both a deterioration in access to the healthcare system and an expression of the increased stress faced by the general population and vulnerable groups in particular.

[What Influence did the Lockdown 2020 have on the Use of a Central Emergency Room by Psychiatric Emergency Patients]

OBJECTIVE

The current coronavirus pandemic (Covid-19 disease) poses major challenges to healthcare systems worldwide. The aim of this work was to identify the impact on psychiatric emergency presentations in an ED during the implemented lockdown.

METHODS

A retrospective survey of all psychiatric emergency presentations in the ED during the lockdown was conducted. The same period in 2019 served as the reference year.

RESULTS

There was a decrease in psychiatric patients. Changes were observed in the age and diagnoses.

CONCLUSION

Some clear effects of the lockdown on psychiatric emergencies in an ED setting can be described. However, the changes were smaller than in other countries with other health care systems.

[Characterization of Ambulant Emergency Contacts in an Emergency Room at a General Hospital]

OBJECTIVE

Scientific interest in emergency psychiatric patients has increased significantly over the last two decades. Nevertheless, current knowledge of this group of patients in the setting of an interdisciplinary emergency department is surprisingly low.

METHODS

A retrospective examination of all ambulatory psychiatric emergency contacts in the emergency room of a regional hospital in 2015 took place.

RESULTS

Solely F4 diagnoses accounted for 48.1 % of all first-time patients. Female patients younger than 25 years used the ER twice as often as their male control-group. Almost half of all outpatients fulfilled no emergency criteria.

CONCLUSION

There are specific age and gender differences. The proportion of patients without any emergency criteria was surprisingly high. More scientific research is needed in order to scrutinize this possible inappropriate use of an ER by psychiatric patients.

[Mental disorders in intensive care medicine - Part 2: Prevention and therapeutic approaches]

This two part article "Mental disorders in intensive care medicine" aims to give an understanding of the most frequent mental disorders in critical care medicine. Part 1 highlights the basics, disturbances and diagnostics, part 2 prevention and therapeutic approaches.

[Mental disorders in intensive care medicine - part 1: Principles and diagnostics]

This two-part article on mental disorders in intensive care medicine aims to provide an understanding of the most frequent mental disorders in critical care medicine. Part 1 highlights the basic principles, disturbances and diagnostics and part 2 deals with prevention and therapeutic approaches. The most frequent mental disorders in the intensive care unit are delirium, substance abuse or, respectively, intoxication, suicide attempts, anxiety disorders, depression or psychosis. Mental disorders may be the reason for admission or can develop in the course of intensive care treatment, such as, for example, a post-traumatic stress disorder. The consequences thereof include increased morbidity, mortality, and duration of hospitalization. The early participation of a psychiatrist in the diagnostic process is to be recommended.

[Suicide and suicidality in emergency medicine]

Emergency physicians, paramedics and the staff of the emergency room play an increasingly important role in the medical and psychological emergency treatment of patients after suicide attempts, as well as in the crisis intervention of persons with acute suicidal tendency. This article aims to give an overview of prevalence rates, method of suicide or attempted suicide, and the problems faced by EPs when treating these patients. In addition, concepts are presented which allow for an adequate risk assessment of suicidality and showing possibilities of primary crisis intervention.

[Psychosocial emergencies--Agitation, aggression and violence in emergency and search and rescue services]

A state of agitation occurs in 15-25% of all patients with mental disorder who are seen by pre-hospital emergency physicians (EPs) in the German emergency medical system. Additionally, there is an unknown number of calls due to injury subsequent to violence. Aggression against EPs and paramedics, however, is rare. This paper gives an overview on the models for the onset of aggression, the single stages of agitation and violence, and the stage-dependent steps for de-escalation and crisis intervention in the emergency situation. Action has to be determined but unexcited and, depending on the situation, swift but well coordinated, including psychopharmacotherapy.

Rapid dose titration of quetiapine for the treatment of acute schizophrenia and acute mania: a case series

To quickly reduce symptoms and to optimize long-term outcome, patients with an acute episode of schizophrenia or mania require prompt treatment intervention. The atypical antipsychotic quetiapine ('Seroquel') has been approved for the treatment of schizophrenia and manic episodes associated with bipolar disorder. For patients with acute symptoms such as aggression or agitation, higher doses of quetiapine than the recommended initiation schedule are often required. This report presents the tolerability findings from rapid initiation with high-dose quetiapine for eight patients who were consecutively admitted with acute symptoms of schizophrenia (n 5) or mania (n 3). The results from this case series show that quetiapine treatment could be safely titrated at a more rapid rate and to doses greater than that described in the current prescribing information. For most patients, rapid dose escalation was well tolerated; no serious side effects were observed and vital clinical parameters were unchanged; one patient experienced transient somnolence. In conclusion, these results suggest that rapid dose escalation of quetiapine could be a useful treatment approach for acutely ill patients with schizophrenia and bipolar mania in order to improve acute symptoms and support the need for randomized controlled trials. However, dose adjustments should be considered with respect to each patient's individual level of tolerability.